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Whether you're employed and insured, elderly and on Medicare, or poor and covered by Medicaid, the Florida Medical Association says there's a growing shortage of doctors — especially specialists — available to provide you with medical care.

And if the Florida Legislature goes along with Gov. Rick Scott's recommendation to offer Medicaid coverage to an additional 1 million Floridians — part of the Affordable Care Act that takes effect next January — the FMA says that shortage will only get worse.

If we are to credit doctors with integrity and disallow any abuse of the system at present or in the future, then it would appear that we already had a doctor shortage or that what doctors we have are not making the best use of their time. To be charitable, let's allow for both.

Things need to change and I don't mean that in a general hippie sense. My doctor doesn't use email at all. I would imagine that there is no payment mechanism for email. However, there needs to be. There is no reason for me to see my doctor as often as I do. I could get the bloodwork at the lab and stop by for vitals from a nurse, and then get an email from the doctor saying, "Your BP is good, your calcium is a little low increase supplement to 1800mg/day and we'll get new bloodwork in six months. Have a nice day."

I take my mother to the doctor (for old age and COPD) three times a year, and two of those visits could as easily be done by a nurse.

Meanwhile, the man who was in the room with me at the hospital was costing the taxpayer much more than he would have if he had been able to get regular management for his diabetes and kidney issues. Because he wasn't getting care until his kidneys had failed, he had to have a dialysis chest catheter put in (dangerous and expensive and requires hospitalization), his arm prepared for future dialysis, and spend weeks in the hospital until he was ready for release and outpatient dialysis. That simply does not make sense. Yes, it would have been cheaper if he had died, but as at least two people came to see him while he was there (I would have guessed he was homeless but apparently not) then obviously it would matter to someone.

We have money for the damnedest things. We apparently have 50 million dollars for a new pier that is boring and useless. Many major cities in the US appear to have gazillions to give away to sports teams, even in dying sports like baseball. We can funnel billions of dollars to agribusiness, energy companies, enemy nations, rathole social institutions, etc...

But in healthcare the argument keeps coming back to those darn people who don't deserve it.

While you were hanging yourself , on someone else's words
Dying to believe in what you heard
I was staring straight into the shining sun

If we are to credit doctors with integrity and disallow any abuse of the system at present or in the future, then it would appear that we already had a doctor shortage or that what doctors we have are not making the best use of their time. To be charitable, let's allow for both.

Or, it could be that the expansion of Medicaid is increasing the ratio of patients to doctors, as the article said:

About 15 million Floridians have health insurance today, and Obamacare, which requires most adults to have coverage by January, could add as many as 2.5 million more. One million would come through a potential expansion of the federal-state Medicaid program that Scott announced this week he was backing. The others would be the result of new mandates requiring employers and individuals to have insurance or be fined.

Currently, the state has 44,804 doctors, but about 5,600 of them are expected to retire in the next five years. And even though Florida has opened three new medical schools in the past dozen years, the state isn't producing as many doctors as it needs. Scott's budget this year has $80 million to fund programs to train 700 new residents a year, in hopes they'll remain in the state.

So, let's do the math, shall we? Fifteen million divided by 44,804 is a patient doctor ratio of 334:1. Assuming the retirement and residency numbers hold, the ratio changes to 17.5 million divided by 42,304, or a ratio of 414:1. No matter how the doctors are managing their time, the ratio of patients to doctors is still going to rise. Nothing charitable need be assumed about it, it's just math. When you increase the number of patients in the pool, and decrease the number of doctors, you get a shortage.

Originally Posted by Novaheart

Things need to change and I don't mean that in a general hippie sense. My doctor doesn't use email at all. I would imagine that there is no payment mechanism for email. However, there needs to be. There is no reason for me to see my doctor as often as I do. I could get the bloodwork at the lab and stop by for vitals from a nurse, and then get an email from the doctor saying, "Your BP is good, your calcium is a little low increase supplement to 1800mg/day and we'll get new bloodwork in six months. Have a nice day."

I take my mother to the doctor (for old age and COPD) three times a year, and two of those visits could as easily be done by a nurse.

So, why aren't those visits handled by a nurse or nurse practitioner or physician's assistant? What do the laws, state and federal, say about who can see a patient? Does Obamacare authorize substitutions? Or does it just assume, like you, that the fault is the doctors' failure to manage their time?

Originally Posted by Novaheart

Meanwhile, the man who was in the room with me at the hospital was costing the taxpayer much more than he would have if he had been able to get regular management for his diabetes and kidney issues. Because he wasn't getting care until his kidneys had failed, he had to have a dialysis chest catheter put in (dangerous and expensive and requires hospitalization), his arm prepared for future dialysis, and spend weeks in the hospital until he was ready for release and outpatient dialysis. That simply does not make sense. Yes, it would have been cheaper if he had died, but as at least two people came to see him while he was there (I would have guessed he was homeless but apparently not) then obviously it would matter to someone.

You keep citing this guy, but Obamacare wouldn't make a difference for him. Even with insurance, there's no guarantee that he'd have shown up for management of his diabetes and kidney issues. Some people don't act on health issues until they become chronic, and don't go for regular check ups, even if they are free. If this guy was homeless, as you thought, it's unlikely that he'd have acted in a responsible manner no matter what was offered him. Citing the same case over and over doesn't make you an expert, and it certainly doesn't make the case that the system is broken.

Originally Posted by Novaheart

We have money for the damnedest things. We apparently have 50 million dollars for a new pier that is boring and useless. Many major cities in the US appear to have gazillions to give away to sports teams, even in dying sports like baseball. We can funnel billions of dollars to agribusiness, energy companies, enemy nations, rathole social institutions, etc...

But in healthcare the argument keeps coming back to those darn people who don't deserve it.

The waste of money in one area doesn't justify wasting it in another. I'd be perfectly happy if we didn't funnel billions of dollars to "agribusiness, energy companies, enemy nations, rathole social institutions, etc... ", didn't give away "gazillions" in tax dollars to sports teams, but that doesn't mean that we have to impose massive new mandates and costs on our healthcare system. Instead of arguing that the waste of tax dollars justifies more waste, why not fight against the waste in all areas, and then look at ways of solving the problems in our system, without destroying it with the single-payer fantasy?

So, let's do the math, shall we? Fifteen million divided by 44,804 is a patient doctor ratio of 334:1. Assuming the retirement and residency numbers hold, the ratio changes to 17.5 million divided by 42,304, or a ratio of 414:1. No matter how the doctors are managing their time, the ratio of patients to doctors is still going to rise. Nothing charitable need be assumed about it, it's just math. When you increase the number of patients in the pool, and decrease the number of doctors, you get a shortage.

Are you sure? My vascular surgeon may only have 414 patients but my GP has many times that and there isn't a wait for either. You are assuming a system overload without showing that it actually exists. Ratio's of 334 to 1 and 414 to 1 mean nothing without looking at the patient breakeven for specific practices and howmany patients these practices currently have. The article gives us no idea what they are so we have no way of knowing if they are good or bad. Personally, if I was in business and told that I was going to have a 24% in customers I would be quite happy and doing everything I could to make sure I could meet that increase not bemoning the fact that government was forcing more customers on me...

So, why aren't those visits handled by a nurse or nurse practitioner or physician's assistant? What do the laws, state and federal, say about who can see a patient? Does Obamacare authorize substitutions? Or does it just assume, like you, that the fault is the doctors' failure to manage their time?

My pain management specialist as well as wound care specialist use PA's so I imagine it depends on the specialty and size of the practice. Also, since the charge to the healthcare system would be the same I doubt it would matter if there were substitutions. I had assumed that Novaheart's point was that by using a doctors time less, and other qualified practitioners more, we could lower the cost of medicine but I doubt if either doctors or insurers would stand for that as it would mean less money in their respective pockets...

The waste of money in one area doesn't justify wasting it in another.

Why it a waste in another area? I doubt that there is a doctor out there who would say preventive medicine is a waste of money. Simply because one person, as in your example, doesn't seek medical attention doesn't mean others won't. If only half take advantage this will translate to millions nationally who, at least once in their lives, are removed from our emergency rooms and hospital rooms because of preventive care. As such, anything that has the propensity to lower individual total healthcare cost, not to mention increase quality of life, is a positive use of money and anything but a waist in another area...

You would think they would have enough doctors, with all those old folks down there.

Doctors around here have signs that say "Accepting new patients." sometimes specifying a preferred insurance or one previously refused (like Medicare Advantage) .

Hospitals around here advertise for patients. Palms of Pasadena is advertising dangerous bariatric surgery and giving away one in a promotion. HCA West Florida spends a fortune on advertising how accessible their emergency rooms and obstetric practices are.

This does not appear to be an overburdened system. I'll let you know when the TV commercials and billboards come down.

While you were hanging yourself , on someone else's words
Dying to believe in what you heard
I was staring straight into the shining sun

Doctors around here have signs that say "Accepting new patients." sometimes specifying a preferred insurance or one previously refused (like Medicare Advantage) .

Hospitals around here advertise for patients. Palms of Pasadena is advertising dangerous bariatric surgery and giving away one in a promotion. HCA West Florida spends a fortune on advertising how accessible their emergency rooms and obstetric practices are.

This does not appear to be an overburdened system. I'll let you know when the TV commercials and billboards come down.

We had a clinic here that was advertising on the radio a "2 for the price of 1" plastic surgeries.

My dad and his wife live over on the Gulf side of the state and neither one of them has any trouble seeing their doctors. My dad also can go to Bay Pines for treatment of his polio-related issues, if the local doctor is too busy to see him.

Are you sure? My vascular surgeon may only have 414 patients but my GP has many times that and there isn't a wait for either. You are assuming a system overload without showing that it actually exists. Ratio's of 334 to 1 and 414 to 1 mean nothing without looking at the patient breakeven for specific practices and howmany patients these practices currently have. The article gives us no idea what they are so we have no way of knowing if they are good or bad. Personally, if I was in business and told that I was going to have a 24% in customers I would be quite happy and doing everything I could to make sure I could meet that increase not bemoning the fact that government was forcing more customers on me...

And if you couldn't meet the increase, what would you do? Remember, these are medical services, not widgets. A doctor's time can only be divided so far. The use of LPNs, PAs and others may alleviate that, but then you get into the question of whether the patient is getting the same care that a physician would provide. The point is not the specific break-even points for each practice, but the overall decline in the doctor:patient ratio.

Originally Posted by PeterS

My pain management specialist as well as wound care specialist use PA's so I imagine it depends on the specialty and size of the practice. Also, since the charge to the healthcare system would be the same I doubt it would matter if there were substitutions. I had assumed that Novaheart's point was that by using a doctors time less, and other qualified practitioners more, we could lower the cost of medicine but I doubt if either doctors or insurers would stand for that as it would mean less money in their respective pockets...

Ah, so it comes back to the greedy insurance companies and doctors.

Originally Posted by PeterS

Why it a waste in another area? I doubt that there is a doctor out there who would say preventive medicine is a waste of money.

I didn't say that preventive care is a waste, but having the government mandate it certainly will be. Nova's argument was that since government wastes taxpayer funding on dubious enterprises, we should not object to the use of taxpayer funding on even more dubious enterprises, such as controlling healthcare. However, the experience of every other country that has adopted nationalized health care demonstrates that government is a poor medical provider. Britain's NHS demonstrates how increasing demand for services leads to increased costs, rationing of care, poorer service and rampant bureaucracy. The only people who don't benefit from state-run health care are the providers and the patients. Government expansion into another sector of the economy, after decades of demonstrated incompetence in the areas that it has already encroached on, is the waste.

Originally Posted by PeterS

Simply because one person, as in your example, doesn't seek medical attention doesn't mean others won't. If only half take advantage this will translate to millions nationally who, at least once in their lives, are removed from our emergency rooms and hospital rooms because of preventive care. As such, anything that has the propensity to lower individual total healthcare cost, not to mention increase quality of life, is a positive use of money and anything but a waist in another area...

But this doesn't have the propensity to lower costs. How do you lower individual healthcare costs by expanding the number of consumers, while not expanding the supply of practitioners? If you increase the demand for a product without increasing the supply, you drive the cost up, not down. This is one of the simplest concepts in economics, yet you don't seem to grasp it.